Examination Application Form

Backlog - Session 2020-22

Type of Programme PG
Name of Course /Semester MASTER OF ART(ENGLISH) - Semester - III
Name of College/Institute C.M.College, Darbhanga-(202)
Registration No 1621300019
Roll No 202022100080

PERSONAL DETAILS
Full Name of The Applicant : MAHE ZARRIN
Father's/Husband's Full Name : SARFARAZ AHMAD
Mother's Full Name : RAKHSHAN ROOHI
Correspondence Address (With Pin Code) Permanent Address (With Pin Code)
MOH-SUBHASH CHOWK,PO-LALBAGH,PS-TOWN MOH-SUBHASH CHOWK,PO-LALBAGH,PS-TOWN
,846004 ,846004
E-mail-ID : mahezarrindbg1999@gmail.com Contact No. : 7070852419
Date of Birth : 10/08/1999 Applicant Gender : FEMALE
Category : UR Differently Abled/Divyang : NO
SUBJECT OFFERED
SUBJECT CODE SUBJECT NAME PAPER TYPE
CC-10 CC-10 Compulsory Paper
CC-11 CC-11 Compulsory Paper
CC-12 CC-12 Compulsory Paper
CC-13 CC-13 Compulsory Paper
CC-14 CC-14 Compulsory Paper
AECC-II AECC-II Compulsory Paper
Receipt No. & Date of payment of exam fees : order_KzEHKB4lZzlm2M 02-01-2023 13:10:26 507

Date: Applicant Signature

Student Declaration :
Examination 2020-22
Backlog Student
Name of Examination : (MASTER OF ART(ENGLISH))
Medium : 101 Semester : Semester - III
Exam & Other Fees. (D.D/University cash receipt no : order_KzEHKB4lZzlm2M) Total Fee Rs. : 507
a. As per provision of the LNMU, ordinances and regulations of examination,I have participated in all activities.
b. As is not permitted in the Ordinance, I am not appearing in any other Examination.
c. I solemnly affirm that the complete information given in this application form is true and correct. If any information given in this form
found to be false I shall be eligible for imposition of fine and punishment & shall be personally responsible for any loss.
d. I understand that my application form shall be rejected or result of examination shall not be declared in case of appearing any
discrepancy/deficiency in this application form as well as for non-compliance of the same within the stipulated time.

Date : Applicant Signature

( Student should take printout of two copies & one copy Submit to College/Institute )